Effects of Ice Massage Prior to an Iontophoresis Treatment Using Dexamethasone Sodium Phosphate

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: Low current intensity iontophoresis treatments have increased skin perfusion over 700% from baseline potentially altering drug clearance from or diffusion to the targeted area. Objective: To determine the effects of a preceding 10-minute ice massage on subcutaneous dexamethasone sodium phosphate (Dex-P) concentration and skin perfusion during and after a 4-mA iontophoresis treatment. Design: Controlled laboratory study. Setting: Research laboratory. Patients or Other Participants: Twenty-four participants (male = 12, female = 12; age = 25.6 [4.5] y, height = 173.9 [8.51] cm, mass = 76.11 [16.84] kg). Intervention(s): Participants were randomly assigned into 2 groups: (1) pretreatment 10-minute ice massage and (2) no pretreatment ice massage. Treatment consisted of an 80-mA·minute (4 mA, 20 min) Dex-P iontophoresis treatment. Microdialysis probes (3 mm deep in the forearm) were used to assess Dex-P, dexamethasone (Dex), and its metabolite (Dex-Met) concentrations. Skin perfusion was measured using laser Doppler flowmetry. Main Outcome Measure(s): Microdialysis samples were collected at baseline, at conclusion of treatment, and every 20 minutes posttreatment for 60 minutes. Samples were analyzed to determine Dex-Total (Dex-Total = Dex-P + Dex + Dex-Met). Skin perfusion was calculated as a percentage change from baseline. A mixed-design analysis of variance was used to determine Dex-Total and skin perfusion difference between groups overtime. Results: There was no difference between groups (P = .476), but [Dex-Total] significantly increased over the course of the iontophoresis and posttreatment time (P < .001). Dex-P was measured in 18 of 24 participants with a mean concentration of 0.67 (1.09) μg/mL. Skin perfusion was significantly greater in the no ice treatment group (P = .002). Peak skin perfusion reached 27.74% (47.49%) and 117.39% (103.45%) from baseline for the ice and no ice groups, respectively. Conclusions: Ice massage prior to iontophoresis does not alter the tissue [Dex-Total] even with less skin perfusion.

Smith, Draper, and Hyldahl are with the Department of Exercise Sciences, Brigham Young University, Provo, UT, USA. Rigby is with the Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City, UT, USA.

Rigby (Justin.Rigby@health.utah.edu) is corresponding author.
  • 1.

    Benjamin SJ, Flood JN, Bechtel R, Alon G. Measurement of soft tissue temperature and impedance following the application of transdermal direct current. Physiotherapy. 2007;93(2):114120. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Rai R, Srinivas C. Iontophoresis in dermatology. Indian J Dermatol Venereol Leprol. 2005;71(4):236. PubMed ID: 16394430 doi:

  • 3.

    Gurney AB, Wascher DC. Absorption of dexamethasone sodium phosphate in human connective tissue using iontophoresis. Am J Sports Med. 2008;36(4):753759. PubMed ID: 18192495 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Rigby JH. Pharmacokinetics of dexamethasone delivered via iontophoresis. J Orthop Sports Phys Ther. 2015;45 (3):190197. PubMed ID: 25679344 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Anderson CR, Morris RL, Boeh SD, Panus PC, Sembrowich WL. Effects of iontophoresis current magnitude and duration on dexamethasone deposition and localized drug retention. Phys Ther. 2003;83(2):161170. PubMed ID: 12564951 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Stahl M, Bouw R, Jackson A, Pay V. Human microdialysis. Curr Pharm Biotechnol. 2002;3(2):165178. PubMed ID: 12022259 doi:

  • 7.

    Gurney B, Wascher D, Eaton L, Benesh E, Lucak J. The effect of skin thickness and time in the absorption of dexamethasone in human tendons using iontophoresis. J Orthop Sports Phys Ther. 2008;38(5):238245. PubMed ID: 18448879 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Berliner MN. Skin microcirculation during tapwater iontophoresis in humans: cathode stimulates more than anode. Microvasc Res. 1997;54(1):7480. PubMed ID: 9245647 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Droog E, Sjöberg F. Nonspecific vasodilatation during transdermal iontophoresis—the effect of voltage over the skin. Microvasc Res. 2003;65(3):172178. PubMed ID: 12711258 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Tartas M, Bouye P, Koitka A, et al. Cathodal current-induced vasodilation to single application and the amplified response to repeated application in humans rely on aspirin-sensitive mechanisms. J Appl Physiol. 2005;99(4):15381544. PubMed ID: 15976365 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Abramson D, Tuck S Jr, Lee S, Richardson G, Chu L. Vascular basis for pain due to cold. Arch Phys Med Rehabil. 1966;47(5):300305. PubMed ID: 5327952

  • 12.

    Fiscus KA, Kaminski TW, Powers ME. Changes in lower-leg blood flow during warm-, cold-, and contrast-water therapy. Arch Phys Med Rehabil. 2005;86(7):14041410. PubMed ID: 16003672 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ho SS, Coel MN, Kagawa R, Richardson AB. The effects of ice on blood flow and bone metabolism in knees. Am J Sports Med. 1994;22(4):537540. PubMed ID: 7943521 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Ho SS, Illgen RL, Meyer RW, Torok PJ, Cooper MD, Reider B. Comparison of various icing times in decreasing bone metabolism and blood flow in the knee. Am J Sports Med. 1995;23(1):7476. PubMed ID: 7726354 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Jutte LS, Merrick MA, Ingersoll CD, Edwards JE. The relationship between intramuscular temperature, skin temperature, and adipose thickness during cryotherapy and rewarming. Arch Phys Med Rehabil. 2001;82(6):845850. PubMed ID: 11387593 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Karunakara RG, Lephart SM, Pincivero DM. Changes in forearm blood flow during single and intermittent cold application. J Orthop Sports Phys Ther. 1999;29(3):177180. PubMed ID: 10322591 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Weston M, Taber C, Casagranda L, Cornwall M. Changes in local blood volume during cold gel pack application to traumatized ankles. J Orthop Sports Phys Ther. 1994;19(4):197199. PubMed ID: 8173566 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Khoshnevis S, Craik NK, Brothers RM, Diller KR. Cryotherapy-induced persistent vasoconstriction after cutaneous cooling: hysteresis between skin temperature and blood perfusion. J Biomech Eng. 2016;138(3):031004. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Knobloch K, Grasemann R, Spies M, Vogt PM. Midportion Achilles tendon microcirculation after intermittent combined cryotherapy and compression compared with cryotherapy alone: a randomized trial. Am J Sports Med. 2008;36(11):21282138. PubMed ID: 18641371 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Knight KL, Draper DO. Therapeutic Modalities: The Art and the Science. Philadelphia: Lippincott Williams & Wilkins; 2008.

  • 21.

    Bjordal JM, Demmink JH, Ljunggren AE. Tendon thickness and depth from skin for supraspinatus, common wrist and finger extensors, patellar and Achilles tendons: ultrasonography study of healthy subjects. Physiotherapy. 2003;89(6):375383. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Zemke JE, Andersen J, Guion WK, McMillan J, Joyner AB. Intramuscular temperature responses in the human leg to two forms of cryotherapy: ice massage and ice bag. J Orthop Sports Phys Ther. 1998;27(4):301307. PubMed ID: 9549714 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Paturi J, Kim HD, Chakraborty B, Friden PM, Banga AK. Transdermal and intradermal iontophoretic delivery of dexamethasone sodium phosphate: quantification of the drug localized in skin. J Drug Target. 2010;18(2):134140. PubMed ID: 19772394 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Hu L, Batheja P, Meidan V, Michniak-Kohn BB. Iontophoretic transdermal drug delivery. In: Vitthal SK, ed. Handbook of Non-Invasive Drug Delivery Systems. Boston, MA: William Andrew Publishing; 2010:95118.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Hao J, Ghosh P, Li SK, Newman B, Kasting GB, Raney SG. Heat effects on drug delivery across human skin. Expert Opin Drug Deliv. 2016;13(5):755768. PubMed ID: 26808472 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kalia YN, Naik A, Garrison J, Guy RH. Iontophoretic drug delivery. Adv Drug Deliv Rev. 2004;56(5):619658. PubMed ID: 15019750 doi:

  • 27.

    Prausnitz MR, Langer R. Transdermal drug delivery. Nat Biotechnol. 2008;26(11):1261. PubMed ID: 18997767 doi:

  • 28.

    Chen Q, Zielinski D, Chen J, Koski A, Werst D, Nowak S. A validated, stability-indicating HPLC method for the determination of dexamethasone related substances on dexamethasone-coated drug-eluting stents. J Pharm Biomed Anal. 2008;48(3):732738. PubMed ID: 18722070 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Heiss JD, Papavassiliou E, Merrill MJ, et al. Mechanism of dexamethasone suppression of brain tumor-associated vascular permeability in rats. Involvement of the glucocorticoid receptor and vascular permeability factor. J Clin Investig. 1996;98(6):14001408. PubMed ID: 8823305 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Gudeman SD, Eisele SA, Heidt RS, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by lontophoresis of 0.4% dexamethasone a randomized, double-blind, placebo-controlled study. Am J Sports Med. 1997;25(3):312316. PubMed ID: 9167809 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Nirschl RP, Rodin DM, Ochiai DH, Maartmann-Moe C. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis: a randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2003;31(2):189195. PubMed ID: 12642251 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Rigby JH, Mortensen BB, Draper DO. Wireless versus wired iontophoresis for treating patellar tendinopathy: a randomized clinical trial. J Athl Train. 2015;50(11):11651173. PubMed ID: 26509681 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Egawa M, Hirao T, Takahashi M. In vivo estimation of stratum corneum thickness from water concentration profiles obtained with Raman spectroscopy. Acta Derm Venereol. 2007;87(1):48. PubMed ID: 17225007 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 152 152 152
Full Text Views 6 6 6
PDF Downloads 4 4 4